it can start with one healthcare worker. The healthcare worker ca- pable of fostering a therapeutic alliance built on trust and rooted in empathy will enhance the possibility for healthy communication and connection, naturally decreasing stigma. Friends, family, and caregivers can also be educated in empathetic communication with the older adult to normalize mental illness and treatment.
Self-Assessment Quiz Question #3 Social determinants of health can enhance or inhibit care for the older adult. When the healthcare worker assesses Internet ac- cess and connectivity along with the technological capabilities of the older adult for telemental health follow-ups, the health- care worker is exploring which social determinant of health?
a. Healthcare access and quality. b. Education access and quality. c. Social and community context. d. Stigma. ASSESSMENT CONSIDERATIONS FOR THE OLDER ADULT
Addressing mental health needs in the older adult will depend on the assessment recorded or provided to the healthcare worker. Assessment is not a single interaction; rather, it is a calculated and continuous process that evolves throughout the care for the old- er adult client (Boyd, 2017). The first interview can set the tone. Preparation prior to meeting the client is encouraged. The healthcare worker can review common developmental tasks of the older adult at any point while providing mental healthcare. Developmental tasks of the older adult are to maintain body im- age and physical integrity, to conduct a life review, to maintain sexual interests and activities, to deal with the death of significant loved ones, to accept the implications of retirement, to accept the genetically programmed failure of organ systems, to divest oneself of the attachment to possessions, and to accept changes in relationships with grandchildren (Sadock et al., 2015). Any of these tasks can be explored in more depth to establish known protective factors or barriers to the mental health of the older adult. An assessment is a deliberate and systematic gathering of infor- mation with the goal of formulating a plan. A mental health as- sessment includes biopsychosocial data to show current and pre- vious health, functional ability, and problems/diseases/illnesses both present and future (Boyd, 2017). The mental health assess- ment includes the biological domain, that is, the physical status of the client. This assessment is often carried out in conjunction with the client’s primary care provider. Biological data is impor- tant to the mental healthcare worker; however, a team approach to the older adult can serve the client best by allowing multiple disciplines to focus on their specialty area of practice. The medi- cal record for the older adult can be quite involved. However, a records review and collaboration with the older adult client’s primary care provider can benefit the holistic picture of the men - tal health needs to be addressed. Physical problems or disorders can be exacerbated or accounted for by addressing the underly- ing psychiatric disturbance. The overlap of biological problems and psychosocial problems can be complicated. The American Geriatric Society (AGS) organizes geriatric health via alliteration for ease of remembrance. The five M’s of older age are multicom - Healthcare directives Advanced care planning can be completed for clients of any age; however, it is responsible to offer the option to all older adults pri- or to medical crises or the end of life. The mental healthcare pro- vider can support the older adult in these legal and ethical plans according to policy. Advanced care planning decisions include measures that can be taken in an emergency: cardiopulmonary resuscitation, use of a ventilator, artificial nutrition such as tube feedings or intravenous fluids, and comfort care measures (NIA, 2018). Older adults need to be aware of the risks and benefits of these differing emergency measures. Older adults with multiple comorbidities are less likely to recover from cardiopulmonary re- Healthcare provider exceptions to confidentiality There are notable exceptions to confidentiality for the healthcare worker meeting the mental health needs of the older adult. The healthcare provider should refer all scope of practice questions to their state regulatory agency. State laws define the scope of practice. Understanding confidentiality, and when to breach it, is a necessary discussion when caring for older adults. Confidenti - ality is a client’s right for restricted information (Boyd, 2017). All
plexity, mind, mobility, medication, and what matters most (AGS, 2020). Multicomplexity is the description of the older adult as a client with comorbid biopsychosocial needs that can challenge the healthcare worker. Mobility refers to the level of autonomous or diminished functionality of the older adult, especially the abil- ity to ambulate and care for themselves. Medication is typically remarkable for the older adult; polypharmacy can be common and problematic and often results in undesirable side effects that signal a strict need for regular consolidation evaluation. The final ideal, mattering most, encompasses the notion of aging and deci- sion making to include the older adult as an advocate for health decisions and goals. This depiction can aid the mental healthcare worker to conceptualize the older adult’s biopsychosocial needs. Assessing the older adult as they present in their current level of functioning is paramount and requires establishing trust and building rapport. The psychiatric interview is the most important part of the mental health assessment. It provides an opportunity to positively impact older adults suffering from mental health is- sues and illnesses. Approaches that can enhance the therapeutic alliance include the following aspects (Boyd, 2017): ● Establishing a relationship rooted in cultural competence and cultural humility. ● Availability to assist in times of crisis. ● Awareness of acute safety issues related to the patient. ● Ability to provide education and manage expectations. ● Review and modification of treatment to individual prefer - ences. ● Realistic intervention and goal setting. ● Support for patient to maintain safe autonomy. Every interaction provides the opportunity to strengthen or weak- en this bond and to obtain facts, feelings, and thoughts that can be targeted for treatment. The psychiatric interview can be ad- ministered in any setting (e.g., hospital, clinic, nursing home, resi- dential facility). The length of time allotted or needed will vary by client and setting. Consult your facility for the proper organization of psychiatric assessment documentation. suscitation and might need extended ventilator care (NIA, 2018). The healthcare provider seeing the older adult for mental health needs can prompt the discussion with the inclusion of quality of life. Several options exist for an older adult in terms of an ad- vanced directive: living will, durable power of attorney, and other specific medical measures such as a do not resuscitate order or a tissue or organ donation request (NIA, 2018). The mental health- care worker can assist the older adult and family with advance care planning needs to increase the likelihood of receiving de- sired treatment during crises or the end of life.
healthcare workers play a role in maintaining client confidentiality. The HIPAA of 1996 is a federal guarantee of legal protection for privacy and confidentiality. Exceptions to confidentiality (when the need to inform outweighs
confidentiality) include the following (Boyd, 2017): ● Client has an intent to harm self or others. ● Litigation if an attorney is involved.
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